Tackling TB in the exotic land of ... North Carolina?

When I told my friends about my summer plans, many were surprised to hear that tuberculosis still existed in the US, not to mention, right here in North Carolina. Many of us were under the impression that TB was something that had been eradicated in the US, "like polio". While TB has become relatively uncommon in the US, especially in comparison to many countries which suffer from a high incidence (8 million new cases per year, 2 million deaths per year world-wide), in 2007 there were 13,299 cases reported in the US, which is about 4 per 100,000 population (WHO). That may not seem like a lot, but the problem is significant because it is concentrated in certain high risk populations which include: foreign-born individuals, persons with problems of substance abuse, HIV positive patients, and the homeless. 

Case of TB

(source: /sites/default/files/posts/tuberculosis-cough.jpg)

As per the latest state report on TB (2008), North Carolina is ranked as the 22nd highest state for TB case rates in the nation (in 1980, it was #3).  In 2008, there were 335 total cases in the state,  40 of which were located in Wake County, and 15 in Durham County. 55% of these cases have at least one of the risk factors that I mentioned earlier, including being born in a country with higher TB incidence than the US, being homeless, excessive alcohol or drug use, and also being a resident of a long-term care or correctional facility, and being HIV co-infected. Even  in the short time that I have been looking at this issue, I have been able to see patients come in who fit these descriptions.

To give you an idea of what population the program is serving today, the most recent data we have from 2009 states there were 22 total cases reported , 68% of which were foreign born (Mexico, El Salvador, Vietnam, India, Jordan, Morocco, Iran, Nigeria, Kenya, Zimbabwe), 77% of cases were male, 2 cases were HIV positive, and 1 case was homeless. 18 cases were of ages 25-64 years. While TB is most common in these populations, there is something about TB that makes it a threat to the entire state and nation - it is very contagious, and if untreated, potentially fatal. So while 22 cases total doesn't sound like a whole lot for an entire clinic to take care of, the reality of the situation is that if a program didn't exist that actively screens, diagnoses, treats, and prevents the transmission of TB, the numbers would be higher, and potentially pandemic. One contagious case, if undetected, could be a threat to the entire nation in a short amount of time because anyone can get TB.

In order to do this, the county TB control program must operate on many levels and serve many functions to a much larger population than just 22 people. As I continue my time here in the program and under the mentorship of Dr. Jason Stout, the state TB Medical Director and assistant professor of medicine at Duke University Medical Center, I hope to get an insider's perspective of just how TB is kept in control and thus generally off of most people's radars thanks to state and national efforts. Additionally, I hope to serve the program by assisting in a couple of studies focusing on TB and HIV care quality improvement and patient's attittudes towards preventive medicine for latent tuberculosis infections, and any other way I can contibute. I hope that through my posts, I can also contribute to other people' understanding and awareness of communicable disease and it's control in the US, especially regarding tuberculosis.  Stay tuned to learn more!